Aids to obstetrics : double part / by Samuel Nall.

  • Nall, Samuel.
Date:
[1885?]
Catalogue details

Licence: Public Domain Mark

Credit: Aids to obstetrics : double part / by Samuel Nall. Source: Wellcome Collection.

    110/150 (page 106)
    in the form of a cone through the vagina and os uteri along the axis of the pelvis ; when in the uterus the hand should be flat- tened out, and passed along the child's abdomen. All move- ments of the hand in the vagina and uterus should be performed in the intervals between the pains. Bupture of the membranes should be avoided, if possible, till the hand is well in the uterus ; they may then be ruptured, and a foot or knee seized and trac- tion exerted on it between the pains ; in consequence of this traction the breech will descend, and ascent of the head should be helped by the external hand. As soon as the leg is brought through the os the labour may, if necessary, be finished by traction. There are two questions of importance in turning, viz.: (a) What part of the foetus ought to he seized ? (h) Which hand ought the operator to use in the uterus ? («) What part of the foetus ought to he seized? If the parts are not fully dilated a foot or knee should be seized, the other limb being left behind to form with the breech a better dilating wedge. If the cervix is well dilated both may be seized. If an arm presents it is best to seize (as advised by Dr. Galabin) the opposite foot, as the force applied to this limb will act with greater advantage in causing the arm to rise up out of the os. (h) Which hand ought the operator to use in the uterus ? As a rule the left-hand should be used, partly because it passes more readily along the pelvic axis, and partly also because the abdomen of the child is generally directed posteriorly, and hence the palm of the hand passing along the child’s abdomen will be more ready to seize the knee or foot. For the same reason, if the child’s abdomen be directed to the front the right-hand should be used. Internal Version in Difficult Cases.—In cases where the liquor amnii has long run off, and the uterus is tightly con- tracted on the foetus, and the shoulder jammed down into the pelvis, version becomes extremely difficult and sometimes im- possible. This is owing to the difficulty of introducing the hand and of rotating the foetus when the hand is introduced ; the cramped position of the hand when in the uterus also